Chapter 3 Person-Driven Care

The Pioneer Network defines culture change as an ongoing transformation in the physical, organizational, and psycho-social-spiritual environments based on person-driven values and restoring control to older adults and those who work closest with them (16). The Foundations of Culture Change, as defined by the Institute for Caregiver Education, asserts five core principles (defined in Table 3.1) (17):

● emphasis on respect ● empowerment choice

● ● relationships ● community MODELS OF CULTURE CHANGE AND

ADVOCACY ORGANIZATIONS The five most prevalent models of culture change include Eden Alternative, Green House Project, Pioneer Network, Wellspring Nursing Home Alliance, and Planetree.

Eden Alternative Eden Alternative is a not-for-profit organization founded by Dr William Thomas, whose philosophy is “that aging should be a continued stage of development and growth, rather than a period of decline. . . . As a comprehensive culture change model, The Eden Alternatve focuses on creating elder-centered commu- nities that thrive on close and continuing relationships, meaningful interactions, opportunities to give as well as receive, and rich and diverse daily life.” Dr Thomas’s first model for change included adding plants, animals, gardens, and patient contact with chil- dren. His idea “expanded to encompass the physical layout of long-term care facilities, called Green Houses” (18).

Green House Project

The Green House Project is a model in which older adults live independently in a self-contained home for 10 to 12 people designed to look like a private resi- dence in the surrounding community (19). “Green House homes are typically licensed as skilled nursing facilities and meet all applicable federal and state regu- latory requirements. Each person who lives in a Green House has a private bedroom and full bathroom, opening to a central hearth/living area and an open kitchen and dining area.” Each home is staffed by a team of universal workers, known as Shahbazim. Instead of providing specialized care tasks such as shower or feeding assistance, the Shahbazim provide

Empowerment Everyone, including staff, residents, and family members, needs to feel as though they make a difference and should be recognized as valued, contributing members of the community.

Choice

Everyone in the community should be given a range of options that reflect personal preference, allowing for flexibility.

Relationships

Bonds among residents, among staff, and between residents and staff should be an ongoing focus.

Community

Social, emotional, spiritual, cognitive, and cultural needs should receive as much atten- tion as medical care.

Source: Institutes for Caregiver Education. Foundations of culture change: underlying principles. www.caregivereduca- tion.org/culture/core_principles.htm. Accessed January 25, 2016.

all the older adult’s direct care needs. Dr. Thomas also redefined and emphasized the concept of convivium— the pleasure that accompanies sharing good food with the people we know well (19). Convivium is encour- aged through older adults sharing meals at a common table. Also, family members, friends, and staff are welcome to join the community at mealtimes and other activities.

Pioneer Network

Pioneer Network was formed in 1997 by a small group of prominent long-term care professionals to advocate for person-directed care. Pioneer Network encourages research that supports culture change, hosts national

TABLE 3.1 Foundations of Culture Change Emphasis Respect

Definition

Each member of the commu- nity, regardless of position (resident or staff member), has the right to voice views, ideas, and opinions without fear. Each person’s view should then be considered prior to a decision.

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